Open enrollment brings tough decisions for chronic disease patients

10.23.18

It’s that time of year again – Americans are beginning to make decisions regarding their health plan for the coming year. In an uncertain health care climate, it’s important for everyone to look closely at their health coverage options and determine which plan will best suit their needs. While open enrollment periods vary across health plans and states, here are three tips to consider as you make decisions about your plan:

Originally, short-term plans were designed for people who may experience a short lapse in health care coverage. These plans only provided three months of coverage, but recent policy changes have extended this period to a year. As a result, many insurers are marketing these plans through promises that they provide comprehensive coverage and offer protections for patients with pre-existing conditions, but that’s simply not the case.

Short-term plans pose dangerous consequences for patients with chronic conditions, as insurers may deny coverage or charge higher premiums based on a person’s health status. If a patient gets sick and requires treatment, the insurer can determine whether it is a result of a pre-existing condition. If so, it excludes the patient from coverage, leaving them with sky-high medical bills.

2. If you rely on copay assistance coupons provided by a drug manufacturer, be sure to read the plan’s fine print.

In a recent article, the Arthritis Foundation and National Organization for Rare Disorders cautioned consumers against an alarming trend: Insurers are refusing to count copay assistance coupons toward a patient’s annual deductible. Chronic conditions, and especially those with rare diseases, often require expensive treatment, which copay coupons help patients afford. Without access to these coupons, patients would be forced to pay thousands of dollars for medication, which may incentivize patients to look for cheaper treatment that may not meet their needs.

Not surprisingly, insurers are hiding this change using confusing medical jargon.

“You look at the premiums. You look at the formularies to see if your drugs are on it. You look at the co-pays and the co-insurance and the deductible,” said Carl Schmid, deputy executive director of the AIDS Institute said to the Washington Blade. “And now this is something else you have to look at.”

Open enrollment periods differ across states and last anywhere between two weeks to over a month. It can be easy to lose track of time and rush to find a plan at the last minute. However, this can lead to hasty decisions that result in a health plan that doesn’t suit your needs. If you are unsure of the deadlines regarding open enrollment in your state, click here.

Throughout open enrollment, it can be helpful to make a list of current medications, doctors and costs to compare coverage across the plans. This can be beneficial for understanding differences in coverage and help you understand what’s most important for your health plan to cover.